Anales Del Sistema Sanitario De Navarra最新文献

Background: In this study, we aimed to present mortality indicators from a database of death causes by age and sex in Navarre (Spain) for 2020: life expectancy at birth, excess mortality, and mortality from COVID-19 and other causes.

Methods: A Poisson regression model, which accounts for temporal trends in the previous years, was used to estimate the expected deaths by sex and age for 2020.

Results: Life expectancy at birth in Navarre for 2020 was 80.6 and 85.9 years for men and women, respectively, 1.4 and 1.0 years lower than in 2019. Deaths in people aged <55 years were similar to those expected. The highest adjusted excess mortality rate occurred among men and women aged >85 years, were 61% of excess deaths was concentrated. The estimated number of excess deaths did not exceed the number of reported deaths from COVID-19. In individuals aged >75 years, around 9 out of 10 people died from COVID-19. Coinciding with the COVID-19 pandemic, there was a remarkable decrease in mortality in people affected by diseases where dementia is included.

Conclusions: The first and second waves of the COVID-19 pandemic reduced life expectancy at birth to figures observed ten years ago. The increase in deaths in Navarre for 2020 is largely attributable to COVID-19.

Background: In this study, we aim to evaluate microangiopathy in HIV positive patients by using capillaroscopy. To date, few studies have been published on the topic. Capillaroscopy may be a tool for early diagnosis of cardiovascular involvement in this patient population.

Methodology: Cross-sectional study with HIV positive patients >18 years. The enrolment period was set from January to June 2018. The following data were collected: demographic (sex, age), laboratory tests (duration of infection, CD4 cell count, CD4:CD8 ratio, coinfection with other viruses), antiretroviral treatment, dyslipidemia, and comorbidities (active smoking, alcoholism, high blood pressure, dyslipidaemia, diabetes, cardiopathy). The capillaroscopy and blood tests were performed simultaneously. The following alterations were evaluated in the capillaroscopy: congestion, tortuosity, haemorrhage, dilations, capillary loss, and presence of megacapillaries.

Results: One hundred and two patients were included; 73.5% were male, mean age was 40 years (SD: 10), and mean duration of infection 4.5 years (SD: 3.1). At diagnosis, mean CD4 cell count was 408/mm3 and CD4/CD8 ratio 0.4. A number of patients (14.7%) were coinfected with the hepatitis B virus; 31.3% were active smokers and 13.7% alcoholics. Capillaroscopy alterations were found in most study patients (93.1%): congestion (78.5%), tortuosity (77.5%), haemorrhage (13.8%), dilations (11.8%), capillary loss (5%), and megacapillaries (1%). Capillary tortuosity was associated with age and smoking; and haemorrhage with age, CD4, antiretroviral treatment, and hypertension.

Conclusion: Prevalence of capillaroscopy alterations is high in HIV positive patients, particularly tortuosity and congestion. To the best of our knowledge, the later alteration has not been previously reported in this group of patients.

Background: To assess pain in patients with rheumatic disease under biological therapy treatment.

Methods: Observational retrospective study of patients with rheumatic disease under biological therapy treatment who visited the health care center as outpatients in February/August 2020. We collected demographic (sex and age), clinical (diagnosis, pain presence, intensity, and location), and pharmacological (biological therapy, concomitant treatment with traditional DMARDs, and analgesic treatment) variables from the electronic medical records and Farmatools Dominion®.

Results: We included 138 patients; mean age was 56 years and 71% were female. The most frequent diagnosis (47%) was ankylosing spondylitis. Anti-TNF-a was the most prescribed biological drug (64%); 60.1% of study patients received traditional drugs, particularly methotrexate and leflunomide (51.8 and 28.9%, respectively). Pain was reported in 81% of the cases, particularly in hands (73.2%) and knees (69.6%); mean pain intensity was 6.5 (VAS). Although 83.3% of the patients had been prescribed analgesics, pain persisted in 84.8% of the cases (VAS >4), being severe or very severe in 67.9%. Over half of the patients (52.2%) used more than one analgesic. The most frequently prescribed medications were non-steroidal anti-inflammatory drugs (NSAIDs) (60%), paracetamol (52.2%), and opioids (56.5%). NSAIDs controlled pain (14.5%) better than opioids (8.3%); there was no post-treatment improvement of pain in 29.6% of the patients. The number of prescribed drugs increased with pain intensity (rho= 0.264; p= 0.006).

Conclusion: Almost 70% of study patients had uncontrolled severe rheumatic-related pain. This implies a challenge for esta­blishing effective treatments for this type of pain.

Currently, among the possible treatments for hepatocellular carcinoma there is group of minimally invasive ablation techniques with wide clinical acceptance due to their greater efficacy and safety in comparison to traditional therapies, low cost, and no need of being admitted to hospital (outpatient treatment program). Irreversible electroporation is a non-thermal ablation technique in which electrical fields are used to create nanopores in the cell membrane that induce tumor cell death. Irreversible electroporation has shown promising results in numerous clinical trials; however, its control on long-term tumor growth and recurrence is inferior in comparison to that of radiofrequency. Combining irreversible electroporation with immunological agents may increase its efficacy in the treatment of focal lesions and metastases. In this work, we present an update on IRE including procedure, mechanism of action, application as a treatment for HCC, and the improvements that have been made in the past few years.

Cutaneous tuberculosis is a rare extrapulmonary pre-sentation of tuberculosis, caused by mycobacterial species of the Mycobacterium tuberculosis complex. We describe a case of cutaneous tuberculosis in a 57-year-old technician from the microbiology laboratory in our hospital. She accidentally experienced a needlestick injury with a hollow needle while at work. Skin lesion developed shortly after on the punctured finger. A biopsy was performed, revealing necrotizing (caseating) granulomatous inflammation. Pharmacological treatment was initiated with four standard drugs: isoniazid, rifampicin, pyrazinamide, and ethambutol hydrochloride. Improvement was observed, but the initial treatment had to be suspended due to intolerance to some of the drugs and changed to a treatment with isoniazid, rifampicin, and levofloxacin. The long duration of the treatment may increase the risk of toxic effects, making it necessary to discard the drug causing these effects and change the treatment regimen.

Background: Genital lichen sclerosus decreases the quality of life of women; 10-15% of cases occur in prepubertal girls.

Methods: Retrospective and descriptive study on the characteristics of girls diagnosed with genital lichen sclerosus at the Hospital Universitario de Navarra (Pamplona, Spain) between 2019 and 2022.

Results: Eleven girls aged between 4 and 14 year-old were diagnosed. Frequently, diagnostic delays were up to two years after the appearance of the lesions; the girl with a four-year delay showed a significant vulvar architectural alteration. All cases showed the typical sclerotic lesions on the genital area, and two of them also on the back. While six patients were asymptomatic, the rest reported pruritus and/or pain. Treatment with high/very high potency topical cortico-steroids achieved a good partial response, without complete remission of the lesions.

Conclusion: Early diagnosis of genital lichen sclerosus is key to start early treatment, avoiding ireversible genital structural alteration.

Cognitive multisensory rehabilitation (CMR) -a therapeutic approach to help recover movement using neurocognitive exercises- activates patient's perceptive and cognitive processes, key for motor learning. The aim of this systematic review was to assess the effectiveness of CMR on motor function and quality of life and compare the findings with other rehabilitation approaches or no-intervention in neurological and trauma adult and pediatric patients. We carried out a systematic review of randomized controlled clinical trials, pilot studies, and case series in PubMed, PEDro, Cochrane Library, and the CINHAL Complete database published between 2012 and 2021. Ten studies met the eligibility criteria. CMR provides similar or superior benefits compared to other types of approaches for the restoration of upper limb function, gait, balance, and quality of life in neurological and trauma patients. Further research with larger samples and higher methodological quality need to be developed to de-termine its long-term effectiveness.